Jan R. Johansen

A system to classify the need for periodontal treatment

A system to determine the periodontal therapeutic needs of a population — the Periodontal Treatment Need System (PTNS) is suggested. It is based on defined diagnostic criteria and systematize the needs according to three standardized therapeutic procedures: (1) individual oral hygiene motivation and instruction (OH), (2) scaling and elimination of overhangs (Sc) and (3) periodontal surgery (Su). The classification is: Class 0 — no need, Class A — need for OH, Class B — need for Sc and OH, and Class C — need for Su, OH and Sc. Class A is given for the mouth and Classes B and C for quadrants. To evaluate the application of the system, 42 patients were treated for inflammatory periodontal disease. The therapy consisted of OH, Sc and Su. The time used for performing the treatment was recorded in each session. The patients were classified according to the system and the average time for each type of therapy was: OH — 72 minutes per patient, Sc — 32 minutes per quadrant and Su — 57 minutes per quadrant. The fol...

Oral roentgenologic findings in a Norwegian urban population

Orthopantomograms were taken of 111 subjects constituting a random sample of 35-year-old citizens of Oslo. The most frequent pathologic finding was marginal bone loss, which was found in seventy-one persons (64%). Fifty-one impacted and unerupted teeth in twenty-eight persons were seen, the third molars predominating. Ten retained roots were found in nine persons, and apical radiolucent areas were found on forty-four teeth in thirty-three persons. In addition to the pathologic findings, 101 endodontically treated teeth in fifty-five persons were observed.

Serum levels of antibodies against Actinobacillus actinomycetemcomitans in various forms of human periodontitis

Serum levels of IgG, IgA, and IgM antibodies against extracts from Bacteroides gingivalis PER8, Actinobacillus actinomycetemcomitans Y4, and Bacteroides fragilis NCTC 9343 were determined in three categories of periodontitis patients by means of enzyme-linked immunosorbent assay. The test groups comprised 10 patients with juvenile periodontitis (JP), 18 young patients with severe periodontitis (YP), and 31 patients with adult periodontitis (AP). Nine subjects with healthy periodontium (HP) served as a reference group. Increased frequencies of patients with significantly elevated IgG and IgA antibody values against B. gingivalis and A. actinomycetemcomitans were found in the three periodontitis groups as compared with the HP group. The AP group, however, showed lower IgM values than the other groups. The results support the contention that A. actinomycetemcomitans may play a contributory role in adult periodontitis and that B. gingivalis is a suspected periopathogenic bacterium in juvenile periodontitis. The clinical YP classification was not supported by the present serologic findings.

Penetration of the oral mucosa by radiolabelled chlorhexidine in guinea pigs

The aim of the present study was to assess the penetration of chlorhexidine through the oral mucosa. Ten albino guinea pigs had the oral cavity exposed to 0.2 % 14C-labelled chlorhexidine for 1 min after initial rinsing with water. Five animals were sacrificed after 30 min and 5 after 60 min. Biopsies from the tongue, palate, gingiva and the buccal mucosa were frozen in liquid nitrogen, cut, fixed and prepared for autoradiography. The surface layers of the epithelium contained the greater part of the labelled material in sections from the tongue, palate and gingiva. Below these heavily labelled surface layers a scattered distribution was noticed throughout the epithelium. Sections from the buccal mucosa showed less surface labelling, but a slight accumulation of label close to the basement membrane was seen. Though labelling was more abundant in the epithelium than in the connective tissue, chlorhexidine had also penetrated into the connective tissue in sections from the buccal mucosa, the gingiva and the...

Average time required for scaling and surgery in periodontal therapy

The time used in performing scaling and elimination of overhangs (Sc) and periodontal surgery (Su) was analysed. Twenty-two quadrants with subgingival calculus and/or restorations with overhanging margins and with pocket depth of 5 mm or less were selected for Sc therapy. Fifty-two quadrants were selected for Su therapy (gingivectomy and/or flap operation). Prescaling had been performed in 38 of them. Six dentists took part in the Sc and 12 in the Su procedures. The mean Sc time per quadrant was 24 minutes (s.d. 7.87) and the mean Su time per quadrant was 52 minutes (s.d. 14.79). Gingivectomy tended to require less time than flap. Prescaling did not seem to reduce the Su time significantly. The averages obtained in this study and in other studies were compared and discussed to evaluate the guidelines suggested in the Periodontal Treatment Need System (PTNS). The PTNS time calculations allowed slight overestimations, mainly for Su time.

Sensitization of guinea pigs with chlorhexidine.

Guinea pigs were immunized with autologous serum exposed to chlorhexidine gluconate. Injections were given every second day for one week. After four weeks the animals were given a booster-dose and were tested for antibodies using the cutaneous anaphylaxis test. The titre of chlorhexidine-treated serum showing a positive reaction was 1: 1000 in immunized animals. Control animals showed positive reaction in a dilution of 1: 10 but negative in 1: 100.

Attachment of human gingival fibroblasts to planed root surfaces exposed to human plasma in vitro

We studied the effect of exposing planed dentin surfaces (DS) to human plasma on the attachment of human gingival fibroblasts (HGF) in vitro as compared with their attachment to citric-acid-demineralized DS. Sixty-six DS were prepared from root-planed roots of surgically extracted human third molars. In a pilot experiment 30 DS were demineralized in citric acid (pH 1.0 for 3 min), and each of 3 DS were placed in a culture dish and incubated with fresh plasma for 0, 10, or 30 sec, 1, 10, or 30 min, or 1, 1.5, 2, or 4h. In a second experiment, three culture dishes containing three DS each were assigned to each of four groups. These were untreated (control), incubated with plasma for 2h, acid-demineralized only, or acid-demineralized and then incubated with plasma for 2h. To each dish was added 0.2 X 10(6) HGF, and these were incubated for 2, 6, or 24 h. The unattached cells were then removed, and the DS fixed and processed for SEM. The results showed that exposing demineralized dentin surfaces to plasma causes the absorption of a coating layer, presumably of organic nature, as early as 30 sec after exposure. Acid-demineralized DS alone or together with plasma treatment enhanced both the attachment and the growth of HGF. However, treatment with plasma alone seemed to enhance the HGF attachment less than did acid demineralization alone.